title: Cardiac tamponade complicating coronary perforation during angioplasty: short-term outcomes and long-term survival.
abstract: BACKGROUND
  Cardiac tamponade constitutes the most severe clinical consequence of a coronary perforation (CP) during percutaneous coronary intervention (PCI).
  
  
  METHODS
  We analyzed 23,399 PCIs and identified 73 patients complicated by CP (0.31%), of which 26 developed tamponade (0.11%). Patients were divided into two groups: CP with tamponade (group A) and CP without tamponade (group B). Characteristics and outcomes were compared and a multivariate model was developed to evaluate the independent contribution of tamponade on mortality.
  
  
  RESULTS
  All patients with tamponade were treated with pericardiocentesis. Tamponade increased the risk of death by more than 3-fold (odds ratio [OR] = 3.3; 95% confidence interval [CI],1.01-10.6; P=.047) relative to patients with CP but no tamponade. CP with tamponade during non-elective PCI carried a significantly worse long-term prognosis (P=.001) than the same complications during elective PCI. The use of glycoprotein IIb/IIIa inhibitors and bivalirudin did not differ between groups. Polytetrafluoroethylene-covered stents were used similarly between the two groups, while coil embolization was used more often in group A (P=.003). Emergent cardiac surgery was needed in 3 patients (11.5%) in group A versus 1 patient (2.1%) in group B.
  
  
  CONCLUSIONS
  Tamponade complicating CP during PCI has short- and long-term major adverse effects. In-hospital mortality after tamponade and referral for emergent surgical treatment have decreased. Nonetheless, tamponade in this setting increases risk of death by >3-fold. PCI of complex lesions with an expected increased risk of perforation should be undertaken cautiously among patients with non-elective PCI because of increased early and late risk of death.
authors.affiliation: Lenox Hill Hospital, Heart and Vascular Institute of New York, Department of Cardiac and Vascular Interventional Services, New York, USA. jastathopoulos@hotmail.com.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Stathopoulos
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kossidas
authors.forename: Georgia
authors.initials: G
authors.lastname: Panagopoulos
authors.forename: Kirk
authors.initials: K
authors.lastname: Garratt
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D006328:Cardiac Catheterization; D002305:Cardiac Tamponade / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D002932:Cineangiography; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D003331:Coronary Vessels / Q000293:injuries*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D009518:New York / Q000453:epidemiology; D020519:Pericardiocentesis; D011446:Prospective Studies; D012421:Rupture; D015607:Stents / Q000009:adverse effects*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome